Our country has the
largest number of people affected with Diabetes. In the previous posts I have
discussed in detail about the cause of the sudden increase in number of
Diabetic population. Few years back Diabetes used to be termed an “Urban
Epidemic” and now with incorporation of various cultures and poor eating habits,
we have successfully made Diabetes an “Indian Epidemic”. In this post I am NOT
going to talk about Diabetes. Instead , I am trying to go into the
psychological aspects revolving around Diabetes. The following text will be
purely based on the experiences my dear patients have gone through. I am not
sure how many of my colleagues try to analyse the patient’s state of mind before
revealing the diagnosis of Type 2 Diabetes. I am sure most of them do....
The people who face the
diagnosis can be broadly classified into three categories.
1.
Patients who have a strong family
history of Diabetes with classical 3P’s (Polyuria, Polyphagia, Polydipsia) of
Diabetes. They generally convince themselves of the diagnosis before they come
for confirmation with blood test. In most cases whether they reveal or not they
would have seen higher numbers in Glucometer /Lab test. These patients are
receptive when the diagnosis is revealed. This acceptance makes it easy to
start off the treatment (Life style modifications/ pharmacological therapy)
immediately.
2.
Patients presenting with classical 3P’s WITHOUT family history of Diabetes.
Well.... there is gonna be starting trouble...
3.
The third group of patients are those in
whom the diagnosis presents without any warning symptoms. The patient would
have undergone a blood test for some other reason and Diabetes comes like bolt
out of the blue... They have no clinical symptoms to suggest Diabetes. These
are the set of people who need a great deal of psychological support.
Diabetes
for many is a spine chilling diagnosis. Advances in science and improved
modalities of treatment have not been able to alleviate the fear. In my
personal opinion the fear is because of
- The very name of Diabetes!
- Fear of insulin pricks which any Diabetic would need, at some point of time.
- Fear of possible damage to kidneys.
- Fear of losing the limb.
- Fear of changing the lifestyle (Daily exercise & Diet restrictions).
- Fear of frequent blood investigations and the cost factor involved.
- Fear of frequent visits to the doctor.
Every patient diagnosed
with Diabetes goes through the stages of (i) Denial and isolation (ii) Anger
(iii) Bargaining (iv) Depression and (v) Acceptance. The time duration of every
stage varies from person to person. In the Indian scenario the stage of denial
means
- Change of Doctor
- Change of Lab which issued the high blood sugar value
- Trial and error with alternative medicine
- Trial with fenugreek, ladies finger, insulin plant and many other native ingredients used in cooking....
- Some try to stick on laboratories which give lower values
- Avoidance of sweets.
The time duration from
stage I to stage V (Denial to Acceptance) has to be considerably reduced so as
to facilitate early institution of therapy and to prevent Diabetes related
short and long term complications.
Indian
mindset does not allow people to access counselling centres. Although the
stature of psychological counselling in India is better that what it was a
decade ago, there is still a long way before people reach out for psychological
help. I feel the treating physician has to take up the role of psychologist as
well as far as Diabetes is concerned. Why? The compliance to therapy whether it
is life style modification of medical nutrition therapy or drugs depends on the
acceptance levels. Going to a psychologist is not well taken by our patients.
If we force them to seek help they are just going to change the doctor leading
to nothing more than delay in initiation of treatment.
Successful
management of Diabetes needs
1. constant
education
2. clarity
on the targets and methods to achieve these targets
3. Clear
discussion regarding mode of action, timing of tablets and side effects.
Every person affected
with Diabetes needs a good amount of support mentally to stick on to the
planned regimen. Once the reward of hard work in terms of good blood sugar
levels is reached, then the patient can motivate himself/herself. Diabetes,
being a chronic condition requiring lot of dedication from the patient as well
as his family. It would be better if the
doctor would keep in mind the psychological aspects as well. This will help in
improving compliance to regimen planned, ease in attaining targets and delay /
prevention of Diabetes related complications. In a nut shell we can make THE
difference by providing better quality of LIFE!
